Author: Jennifer Zanotti, MS, RN, CEN, CCRN
Title: Clinical Education Center Instructor
Institution: University of Colorado Denver College of Nursing
Coauthors: Fara Bowler, MS, RN, C-ANP Kerri Reid, MS, RN, CNS
Pre-Licensure ADN/Diploma, Pre-Licensure BSN
Skills or Simulation Laboratories
- Examine human factors and other basic safety design principles as well as commonly used unsafe practices (such as work-arounds, and dangerous abbreviations).
- Demonstrate effective use of strategies to reduce risk of harm to self and others.
- Appreciate the cognitive and physical limits of human performance.
- Communicate observations or concerns related to hazards and errors to patients, families, and the health care team.
- Value own role in preventing errors.
- Value vigilance and monitoring (even of own performance of care activities) by patients, families, and other members of the health care team.
This clinical learning activity is appropriate for early clinical courses in a pre-licensure curriculum. In Colorado, where this strategy was developed, this simulation is used in Fundamentals of Nursing.
This is a low fidelity simulation exercise that emphasizes environmental safety to nursing students. The student can best perform this learning activity after content of asepsis, infection control and safety have been taught.
The student is invited into a simulated hospital room, where a low fidelity mannequin lies in bed. The student is asked to identify any compromise in this patient’s environmental safety that he/she sees. As the hazard is identified, the nursing student is asked to address the best way to correct the hazard, and create a more safe patient room environment. The students are given the following scenario with limited details:
One of your patients is Mr. Neat. In report you learn that Mr. Neat is a 64 y.o. gentleman admitted to you unit 3 days prior for a R leg wound that has become worse. An irrigation and drainage was performed on this R leg wound the previous night, and a C&S culture was sent to the lab from the OR. There are no results reported yet for this C&S. Mr. Neat is a Type 2 diabetic on insulin, and he has has COPD, for which he wears 2L of 02 per nc. Mr. Neat has a chronic productive cough, for which he likes to use the yankeur suction to facilitate removal of the mucus he is coughing up. The doctor has ordered that Mr. Neat be ambulated this morning.
You are entering Mr. Neat’s room for the first time during your day shift and Mr. Neat is sleeping quietly. This activity centers on your assessment of Mr. Neat’s environment while he is sleeping. There are 15 compromises in Mr. Neat’s patient room environment. Name 12. Please address how you would remedy each hazard that you identify. You have ten minutes for your environmental assessment.
The student is expected to be able to identify 12 of the following 15 environmental hazards:
1. A 4X4 piece of gauze with serosanguinous drainage sits at the foot of the bed 2. There is a visible uncapped insulin syringe in the bed, alongside the patient 3. The bed’s wheels are unlocked 4. The suction mechanism is missing the connector tubing and the apparatus is set up incorrectly 5. The bed is in the high position 6. There is various debris on the floor (e.g. needle caps, a bandaid, and a potato chip bag) 7. The patient’s IV tubing is obstructing the patient’s pathway to the bathroom. 8. The sharps container is totally full 9. There is an unsafe rug on the floor that could easily slip out from under someone. 10. The patient has no footwear (slippers or hospital booties). 11. There is an overflowing trashcan, with a red hazardous material bag open at the top. 12. There are loose unidentified pills on the over the bed table 13. The oxygen tubing is disconnected from the 02 christmas tree and the 02 is set at 2L. 14. There are dirty Kleenexes in the bed and on the floor alongside the bed 15. A part of the paper chart has been left on the bedside table with sensitive information about the patient’s history (e.g. details of the patient’s history of mental illness, or a sensitive aspect of the patient’s psychological/social history like a recent divorce)
This activity is most easily evaluated as a pass/fail activity. The instructor can use a checklist to keep track of the hazards that the student identifies or misses.
Evaluative support to the student can be similar to other simulation debriefing where the student provides reflection on his/her strengths, what was missed and what he/she learned from the learning activity. It is also helpful during the debrief to have the student describe the clinical implications of the environmental hazards (e.g. hypoxia from the unhooked 02 can lead to respiratory arrest, transmission of bacteria by the contaminated gauze and open hazardous material bag can lead to nosocomial infections for other patients, a patient fall from the rug and lack of foot wear can result in serious injury to the patient etc…)